SUPPORTED DENTISTS - BENEFITS OVERVIEW | PLAN YEAR 2018-2019

December 1, 2018 through December 31, 2019

We are happy to hear you are considering joining a Pacific Dental Services®, LLC (PDS®) supported office.
The quest for excellence inspires everything that defines us. We focus on everyone’s distinctive talents
and strengths. Our passion for the business and the future drives us to be the best. PDS continues to
experience rapid growth, year over year. This is a brief summary of the many additional benefits PDS
offers to Team Members.
Full-time (FT) Benefits Overview
• Team Members who are regularly scheduled at least 30 hours For most of our benefit plans, your coverage will become effective
or more per week. on the first day of the month following one month of continuous
service, which includes any orientation period and new hire
Part–time (PT)
benefits eligibility waiting period.  You have 30 days from the date
• Team Members who are regularly scheduled less than 30 hours
of hire to enroll. 
per week.
* Part-time Team Members are eligible for Dental, 401(k), Voluntary
Legal, Auto/Home, Pet Insurance and Team Member Discounts.

MEDICAL PLANS

Our Value PPO Plan is designed to provide members choice and
flexibility. Members can choose to see a participating network
physician and pay only a $20 office visit copay (deductible
waived) or they can see other providers of their choice at higher
out-of-pocket costs after satisfying the medical plan deductible.
Generic medications are available for a $10 copay, and Brand
Name and Non-Formulary Brand Name medications are available
at low copays after satisfying the prescription plan deductible.
Our HSA Medical Plan includes 100% coverage for nationally
recommended preventive care services and low cost
preventive medications, not subject to the deductible. Once
the deductible is met the plan provides benefits for medical
services and prescriptions. All medical services are subject to
a 20% in-network and 50% out-of-network coinsurance, up to
an out-of-pocket maximum, and prescriptions are subject to
copayments after the medical plan deductible has been met.

Anthem Value PPO Plan Anthem HSA Plan

Medical Plan Coverage Summary Medical Plan Coverage Summary
Coverage In-Network Out-of-Network*** Coverage In-Network Out-of-Network***
Plan Year Deductible Plan Year Deductible
(includes Rx)
Individual* $1,750 $5,000 $1,750 $4,000
Family** $3,500 $10,000 Individual* $3,500 $8,000
Family**
Plan Year Plan Year
Out-of-Pocket Max Out-of-Pocket Max
Individual* $5,000 $10,000 Individual* $3,000 $6,000
Family** $10,000 $20,000 Family** $6,000 $12,000
Office Visit $20 (deductible waived) 50% (subject to Office Visit 20% 50%
deductible) (subject to deductible)
Coinsurance 30% 50% Coinsurance 20% 50%
(after deductible)
(after deductible) Preventive Care No charge 50%
Preventive Care No charge 50% Adult/Children (deductible waived) (subject to deductible)
Adult/Children (deductible waived) (subject to deductible) Prescriptions
Prescriptions Rx Copays (after In-Network Out-of-Network***
deductible)
Rx Copays (after Rx In-Network Out-of-Network*** Preventive Expanded Plan Medications
deductible)
Retail $0
Rx Deductible $150 Individual/$300 Family (30-day supply) (deductible waived)
Mail Order $0
Generic Copay $10 Member pays (90-day supply) (deductible waived) After Deductible is met,
(30-day supply) (deductible does not applicable deductible you pay 30% of the
apply) & copay amounts plus Non-Preventive Prescription Copays maximum allowed
50% of the remaining Generic Copay $10 amount, plus any
Brand Copay $40 prescription drug (30-day supply) (after deductible) costs in excess of the
(30-day supply) (Rx deductible applies) maximum allowed maximum allowed
amount & costs Brand Copay $30 amount. Specialty
Non-Formulary Copay $50 in excess of the (30-day supply) (after deductible) drugs & mail order
(30-day supply) (Rx deductible applies) prescription drug Non-Formulary Copay $50 not covered out-of-
maximum allowed (30-day supply) (after deductible) network.
Specialty Drugs Copay 30% of maximum amount.
(30-day supply) allowed amount (max Specialty Drugs Copay 30% of prescription
of $150 copay, Rx (30-day supply) drug maximum allowed
deductible applies) amount
(after deductible)
*Individual: Enrolled as Team Member Only Coverage
**Family: Enrolled as Team Member + One or More Dependents
***Members may incur additional costs, as balance billing may occur if utilizing non-network providers and pharmacies
 SUPPORTED DENTISTS - BENEFITS OVERVIEW | PLAN YEAR 2018-2019
December 1, 2018 through December 31, 2019

The following outlines your pre-tax contributions towards medical premiums on a per pay period basis:

Anthem Value PPO Plan (Not HSA Eligible) Anthem HSA Plan
Tobacco Free (Not HSA Eligible) Tobacco Free

Enrolled Coverage Tier Team Member Cost Enrolled Coverage Tier Team Member Cost

Team Member Only $37.50 Team Member Only $67.50

Team Member + Spouse/RDP $152.50 Team Member + Spouse/RDP $212.50

Team Member + Child(ren) $122.50 Team Member + Child(ren) $172.50

Team Member + Spouse/RDP + $247.50 Team Member + Spouse/RDP + $327.50

Child(ren) Child(ren)

Tobacco User (Not HSA Eligible) Tobacco User

Enrolled Coverage Tier Team Member Cost Enrolled Coverage Tier Team Member Cost

Team Member Only $70.00 Team Member Only $100.00

Team Member + Spouse/RDP $202.50 Team Member + Spouse/RDP $262.50

Team Member + Child(ren) $172.50 Team Member + Child(ren) $222.50

Team Member + Spouse/RDP + $297.50 Team Member + Spouse/RDP + $377.50

Child(ren) Child(ren)

DENTAL PLAN The optional HSA allows you to contribute up to $3,500/

individual or $7,000/family (2019 HSA Contribution Limits)
The Dental Plan provides discounts through PDS®-supported of pre-tax dollars to pay for qualified health care expenses.
offices for preventive, basic, and major dental services, as well In addition to lowering your taxable income, Pacific Dental
as orthodontic services. Services makes semiannual contributions to your Health
Savings Account.
The Dental Plan features no premiums or deductibles, exams
and x-rays at no charge, and a plan year benefit maximum of
PDS Annual HSA Contributions
up to $7,500.
(deposits made semi-annually)
VISION PLAN Tobacco Free Tobacco User
Team Members may elect vision coverage through Vision
Service Plan (VSP). Our Vision Plan provides coverage for exams $500 $400
and lenses every 12 months and frames every 24 months.

ANTHEM LIVEHEALTH ONLINE

LiveHealth Online, allows you to talk to a doctor right away, any time of the day or night, from the comfort of your home or office. This service
should be used for things like colds, flu, headaches, sinus infections, fever, etc. All you need is a smart phone with web service or a computer/tablet
with an internet connection. Members must first register at www.livehealthonline.com.

HSA Plan members pay $49 per visit (which counts toward the plan year deductible and out-of-pocket maximums). Once the deductible is met,
ü
members pay 20% of $49 visit, or $9.80 per visit.
PPO Plan members pay a $5 copay per visit (which will count toward their plan year out-of-pocket maximum).
ü
Members must be located in the state that allows for online services in order to have the online visit and any e-prescribing—if allowed by the state.
ü
 SUPPORTED DENTISTS - BENEFITS OVERVIEW | PLAN YEAR 2018-2019
December 1, 2018 through December 31, 2019

FLEXIBLE SPENDING ACCOUNTS DISABILITY PLANS*

Team Members may elect Flexible Spending Accounts (FSAs) Team Members of supported offices may elect Voluntary
through Navia Benefit Solutions. FSAs provide you with an Short and/or Long Term Disability income benefits through
important tax advantage that can help you pay health care and Cigna. These plans provide a source of income in the event you
dependent care expenses on a pre-tax basis. become disabled from a non work-related injury or sickness.

Limited Health Spending Account: in conjunction with your

HSA: allows you to set aside up to $2,700* of pre-tax dollars Cigna Short Benefit

to cover the cost of qualified dental, orthodontic, or vision Term Disability

expenses not covered through an insurance plan. Plan includes Elimination Period 0 days for injury; 7 days for illness
a $500 carryover feature.
Weekly Benefit 70% of weekly earnings to a
General Purpose Health Spending Account: allows you to set max of $2,000
aside up to $2,700* of pre-tax dollars to cover the cost of
Maximum Duration 16 weeks
qualified medical, prescription, dental, orthodontic, or vision
expenses not covered through an insurance plan. Plan includes Cigna Long Benefit
a $500 carryover feature. Term Disability

Dependent Care Spending Account: allows you to set aside Elimination Period 120 days for injury
up to $5,000 of pre-tax dollars to use towards qualified
dependent care such as caring for your children under age 13 Weekly Benefit 60% of monthly earnings to a
or caring for elders. max of $6,000

*Subject to IRS publication release Maximum Duration Social Security Normal

Retirement Age

LIFE AND ACCIDENTAL DEATH &

DISMEMBERMENT PLANS*
401(K) RETIREMENT & SAVINGS PROGRAM
PDS-supported offices provide Basic Group Life and AD&D
coverage equal to 1x your annual earnings to a maximum of
The PDS® 401(k) plan through Mass Mutual allows you to save a
$500,000.
certain percent of your pay on a pre-tax basis to invest toward
your retirement. Eligible Team Members are automatically
Team Members of supported offices also have the option
enrolled at 4%, effective the first of the month following 90
to purchase additional Supplemental Term Life and AD&D
days. Please visit www.irs.gov for 401(k) yearly limits. In
coverage for themselves and Supplemental Term Life coverage
addition to your contributions, PDS-supported offices offer a
for their dependents.
discretionary matching contribution. (Employer Match is based
on the first 6% of your gross earnings.)
Supplemental Term Life
ü Team Member: $25,000 increments up to maximum of
$1,000,000 (combined with Basic coverage). Plan Features Benefit
ü Spouse: $10,000 increments up to $250,000.
ü Child(ren): $10,000. Current Discretionary $0.33 on the dollar for
Matching Formula the first 6%; not to exceed
Optional AD&D $1,500 per year.
Team Member: $25,000 increments to a maximum of 6x
ü Vesting Schedule After 1 yr - 0% 4 yrs - 60%
your annual earnings to a max of $1,000,000 (combined 2 yrs - 20% 5 yrs - 80%
with Basic coverage). 3 yrs - 40% 6 yrs -100%

Contact Mass Mutual at 800-743-5274 to register, add

beneficiary information and make deferral changes.
 SUPPORTED DENTISTS - BENEFITS OVERVIEW | PLAN YEAR 2018-2019
ADOPTION ASSISTANCE
PDS®/its supported offices will reimburse eligible participants
for a portion of the expenses resulting from the legal adoption
of an eligible child.
BACK-UP CHILD CARE PROGRAM
The Back-Up Care Program provides caregiving solutions
for times when your regular care breaks down. The program
provides low-cost emergency care as well as scheduled care
either in-home or at accredited child care centers.
OTHER VOLUNTARY PLANS
Team Members may elect to enroll in various Voluntary Plan
options at our reduced group rates; and many can be paid
through payroll deduction. These Voluntary Plans include:
ü Long Term Care offered through Unum
ü Critical Illness & Accident coverage offered through Unum
ü Hospital Indemnity Plan through Unum
ü Legal Plan offered through MetLife
ü Pet Insurance offered through MetLife
ü Auto & Home Insurance offered through MetLife
DISCOUNT PROGRAMS
Team Members may take advantage of significant discounts
for memberships and services that include:
ü Health Club Member Discounts through LA Fitness
ü Banking Discounts for services at Bank of the West
and Wells Fargo
ü Sprint Discount Program
ü Verizon Wireless Discount Program
ü Discounts for participation in the FamilyLife
Marriage Conference
REWARDS & RECOGNITION
PDS and its supported offices have service tenure recognition
that celebrates a Team Member’s length of service. We also
celebrate Extraordinary Performance (XP) of individuals
with exceptional behavior and actions of Team Members. In
addition, PDS likes to honor offices of the month, positive
patient correspondence, office of the year, region of the year,
and support department of the year to name a few of the great
rewards. Rewards can include lunch, gift cards, extra days off,
plaques, trophies, bonuses, and even overnight getaways.
MALPRACTICE INSURANCE
Malpractice insurance is provided to all full and part-time
employed dentists at PDS-supported offices. The coverage
begins on the first day of employment and ends upon
termination. Coverage only applies to professional dental
December 1, 2018 through December 31, 2019
services performed at PDS-supported offices, events or
functions. The policy is underwritten by CNA and is a
“Claims Made” policy with limits of $1M per occurrence and
a $3M aggregate.
VACATION
Dentists are not eligible for paid vacation benefits.
SICK TIME
All Team Members in AZ, CA, OR, MA, and St. Paul, MN are
eligible for sick time. This includes full-time, part-time and
temporary Team Members and clinicians.
CONTINUING EDUCATION - THE PDS INSTITUTE®
Clinicians supported by PDS have priority access to world class
education through the PDS Institute. The Institute curriculum
offers a three phase approach in supporting the development
of clinicians, which means regardless of where you are at in
your professional development, we have offerings that will help
you grow. Development offerings include, but are not limited
to: Clinical Skills, Patient Experience, Practice Management,
Mentorship and People Leadership. Coursework is taught by
internal PDS Institute faculty and external key opinion leaders
with the vision of “Clinicians Leading Clinicians in Clinical
Excellence®” and an emphasis on achieving exceptional
outcomes and experiences for healthier, happier patients.
Clinicians supported by PDS have the opportunity to access
over 500 hours of clinical education in over 20 disciplines.
STUDENT LOAN REFINANCING
CommonBond and SoFi are offering special terms for student
loan refinancing for all Team Members. All loans are subject to
the bank’s application and approval process. The terms may be
subject to change by the bank at any time.
BENEFITS QUESTIONS AND HELP WITH
ENROLLMENT
Benefits Advocate
Phone: 877-536-8693
Email: pdsbenefits@alliantinsurance.com